The current state of redo transcatheter aortic valve replacement (TAVR) and limitations: why TAVR explant is important as the valve reintervention strategy
Bibliographic record
Abstract
The rise of transcatheter aortic valve replacement (TAVR) over the past two decades has substantially changed the lifetime management of patients with aortic valve disease. As the indications for TAVR expand to include younger and lower-risk patients, the proportion of patients who subsequently require reintervention for failed transcatheter heart valves (THVs) will increase. The two primary options for reintervention are redo TAVR and TAVR explant followed by surgical aortic valve replacement (SAVR). The indications for redo TAVR in the short term include emergency “bailout” procedures due to malpositioning, embolization, or long-term device failure due to paravalvular leak (PVL) or valvular degeneration. However, redo TAVR is not suitable for all patients. Those with prohibitive coronary anatomy, multivalvular involvement, severe patient-prosthetic mismatch, or endocarditis should be referred for TAVR explant, which is a comparatively higher-risk procedure. Redo TAVR has generally been associated with low mortality and complication rates, with key procedural considerations being valve selection [e.g., sizing, balloon-expandable valve (BEV) vs. self-expandable valve (SEV)], access, and coronary protection. TAVR explant poses numerous technical challenges, including concomitant ascending aorta or aortic root replacement, mitral valve involvement, or adhesions to the coronary ostia. Compared to redo TAVR, TAVR explant is associated with higher rates of short-term mortality and periprocedural complications. The 30-day mortality rates of TAVR explant approach 20%, and 1-year mortality rates range from 20% to 30%, with significantly greater risk associated with concomitant procedures. The data on both redo TAVR and TAVR explant are limited to observational cohorts without long-term follow-up. Given that patient populations and indications for redo TAVR and TAVR explant are vastly different, direct comparisons of outcomes between these two groups should be avoided. Nonetheless, multidisciplinary Heart Team collaboration remains imperative to advancing our knowledge of redo TAVR or TAVR explant procedures and the careful lifetime management of patients with aortic valve disease.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.041 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.007 |
| Scholarly communication | 0.006 | 0.010 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.005 | 0.008 |
| Insufficient payload (model declined to judge) | 0.011 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".